Provider Demographics
NPI:1477556165
Name:BERGER, ROBERT S (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BERGER
Suffix:
Gender:M
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WEST 95TH STREET, SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6612
Mailing Address - Country:US
Mailing Address - Phone:212-865-2360
Mailing Address - Fax:425-871-2360
Practice Address - Street 1:150 WEST 95TH STREET, SUITE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6612
Practice Address - Country:US
Practice Address - Phone:212-865-2360
Practice Address - Fax:425-871-2360
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR020447-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR020447-1OtherNYS LICENSE
NYN41532Medicare PIN